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Introduction
Early mobilization after hip fracture surgery is a widely practiced component of postoperative care. However, there is little evidence to suggest that early mobilization post–hip fracture surgery is beneficial in reducing postoperative complications. This study aims to investigate the effect of early mobilization following hip fracture...
Citations
... According to the results of epidemiological surveys on hip fractures in Japan, approximately 70% of cases occur in people over 75 years of age, but the incidence increases with age starting at 40 years of age [3,4]. In cases with hip fracture, performing early surgical treatment and encouraging patients to leave the bed as early as possible to maintain preinjury mobility are essential measures [5]. However, if a comorbid disease exists, time is required for perioperative management. ...
Background: Identifying older adults with a high risk of falling and providing them with appropriate intervention are vital measures for preventing fall incidents. Scholars report that oral frailty, a decline in oral function, is related to physical function; thus, it bears a potential association with fall risks. This study aimed to investigate the relationship between fall incidents and the status of physical and oral frailty among a sample of residents in Osaka Prefecture. Subjects and Methods: This study targeted community-dwelling people aged 50 years and older who responded to an annual questionnaire survey using a health app for 2 consecutive years, namely, 2020 and 2021. This study analyzed responses from 7591 (62 ± 7 years) participants and determined the status of their oral frailty and comprehensive and physical frailty using the Kihon Checklist. Results: In the 2020 and 2021 surveys, 17% and 19% of the participants exhibited oral frailty and experienced a fall in the previous year, respectively. Logistic regression analysis demonstrated that oral frailty (adjusted odds ratio: 1.553) and physical frailty as well as low levels of awareness of frailty were significant explanatory variables of the occurrence of fall incidents during the subsequent year. Conclusions: Future studies are required to elucidate the mechanisms by which oral frailty induces fall incidents.
... Hence, many nerve blocks like the three-in-one block, FNB, and fascia iliaca compartment block (FICB) have been tried and tested as an alternative analgesic approach to aid in positioning these patients but their efficacy has been suboptimal, probably owing to their inconsistent blockade of articular branches [16]. FNB has been associated with quadriceps muscle weakness resulting in increased postoperative falls and delayed mobility, warranting an alternative technique devoid of that consequence [12,22,23]. The PENG block is a novel regional analgesic technique described by Girón-Arango et al. for hip fractures, and they observed that all patients had lower pain scores without quadriceps weakness [16]. ...
Introduction: Hip fractures cause severe pain during positioning for spinal anesthesia (SA). Intravenous systemic analgesics can lead to various complications in elderly patients, hence peripheral nerve blocks are emerging as a standard of care in pain management for hip fractures, among which femoral nerve block (FNB) is widely known and practiced. Pericapsular nerve group (PENG) block is a recently described technique that blocks the articular nerves of the hip with motor-sparing effects and is used to manage positional pain in hip fractures. This study aims to evaluate the analgesic efficacy of PENG block over FNB in managing pain during positioning before SA in hip fractures.
Materials and methods: This was a prospective, randomized, double-blinded study. After ethical clearance, 70 patients undergoing hip fracture surgery under SA in a tertiary-care hospital were recruited and randomized to receive either ultrasound-guided PENG block or FNB with 20 ml of 0.25% bupivacaine before performing SA. We compared pain severity using the visual analog scale (VAS) 15 and 30 minutes after the block and during positioning. The sitting angle, requirement of rescue analgesia for positioning, and anesthesiologist and patient satisfaction scores were also analyzed. Continuous data were analyzed with an unpaired t-test while the chi-square test was used for categorical data.
Results: There was a significant reduction in VAS scores after PENG block (PENG: 0.66 ± 1.05 and FNB: 1.94 ± 1.90; p = 0.001) with lesser requirement of rescue analgesia for positioning compared to FNB. The anesthesiologist and patient satisfaction scores were also significantly better in the PENG group.
Conclusion: PENG block offers better analgesia for positioning before SA than FNB without any significant side effects, and improves patient and anesthesiologist satisfaction, thus proving to be an effective analgesic alternative for painful hip fractures.
... There were 13 eligible studies (Table 2). Eight studies were retrospective cohort studies (Baer et al., 2019;Ferris et al., 2020;Goubar et al., 2021;Heiden et al., 2021;Kenyon-Smith et al., 2019;Kuru, 2019;Sheehan et al., 2021;Warren et al., 2019). Four studies were prospective (Barone et al., 2009;Oldmeadow et al., 2006;Tan & Vasireddy, 2021;Xiang et al., 2021). ...
... Out of the studies included, one was considered to be level one evidence (i.e. Randomised controlled trial) (Oldmeadow et al., 2006), 10 were level two evidence (Baer et al., 2019; Barone et al., 2009;Ferris et al., 2020;Goubar et al., 2021;Heiden et al., 2021;Kenyon-Smith et al., 2019;Kuru, 2019;Sheehan et al., 2021;Tan & Vasireddy, 2021;Warren et al., 2019;Xiang et al., 2021) (i.e. cohort studies and non-randomised trials) and one was level three evidence Su et al., 2018) (i.e. ...
... Patients treated with a total hip replacement were significantly better mobilised than patients after intramedullary nailing or partial hip replacement (p < 0.001 and p = 0.008). In multivariate analysis, fracture type and fracture treatment were significant: Femoral neck as well as total hip replacement Kenyon-Smith et al., 2019 Patients who mobilised early had a 36% chance of developing complications, whilst patients who did not mobilise had a 52% chance. OR = 1.9, 95% CI p = 0.044. ...
Introduction
The aims of this systematic review and meta‐analysis were to determine if after hip fracture surgery (1) early mobilisation is associated with improved clinical outcomes, and if so (2) are benefits directly proportional to how soon after surgery the patient mobilises.
Methods
A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses systematic review was conducted using four databases to identify all studies that compared postoperative early mobilisation with delayed mobilisation, in patients after hip fracture surgery. The Critical Appraisal Skills Programme checklist was employed for critical appraisal and evaluation of all studies that met the inclusion criteria.
Results
A total of 13 studies, including 297,435 patients were identified, of which 235,275 patients were mobilised early and 62,160 were mobilised late. Six studies assessed 30‐day mortality, of which two also investigated 30‐day complication rates. Pooled meta‐analysis demonstrated that there were significantly lower 30‐day mortality rates (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.31–0.41, p < 0.001) and complication rates (OR 0.43, 95% CI 0.36–0.51, p < 0.001) in patients mobilising early after hip fracture surgery. Five studies investigated length of stay (LOS) and meta‐analysis revealed no difference between groups (mean difference −0.57 days, 95% CI −1.89–0.74, p = 0.39).
Conclusion
Early mobilisation in hip fracture patients is associated with a reduction in 30‐day mortality and complication rates compared to delayed mobilisation, but no difference in LOS. These findings illustrate that early mobilisation is associated with superior post operative outcomes. However, a direct casual effect remains to be demonstrated, and further work on the factors underlying delayed mobilisation is required.
... Postoperative exercise is widely recognized as safe and bene cial, in breast augmentation and other surgeries (6, [9][10][11]. Regular exercise contributes to reducing muscle atrophy, pulmonary complications and length of hospital stay, in addition to improving the functional capacity and quality of life of patients (12)(13)(14). On the other hand, the lack of postoperative exercises is related to complications such as anxiety, depression, increased pain intensity, muscle contractions and adhesive capsulitis (15)(16)(17)(18)(19). ...
Background: Breast augmentation is a surgical procedure that may result in postoperative pain. The use of analgesics to relieve pain may produce adverse effects and delay recovery. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological approach that can relieve pain by activating nerve fibers. However, the effectiveness of TENS in breast augmentation has yet to be investigated. The aim of this study was to assess the effects of TENS on pain intensity immediately after breast augmentation. The results have the potential to advance scientific and technological knowledge in the treatment of acute postoperative pain, using accessible non-pharmacological interventions that can improve patients’ experiences.
● Methods: A placebo-controlled, double-blind randomized clinical trial will be conducted with 52 participants submitted to breast augmentation following a rapid 24-hour recovery. Participants will be randomly allocated to two groups: active TENS and placebo TENS. Each participant will undergo a TENS treatment session. The primary outcome will be pain intensity assessed at rest and during movement, before and immediately after TENS. Secondary outcomes will include pain intensity one hour after treatment, respiratory muscle strength, satisfaction with the intervention and analgesic use in the first four hours after surgery.
● Discussion: The results of this study will provide important information on the effects of TENS in patients submitted to breast augmentation, contributing to improving ´postoperative pain. It is hoped that the findings of a non-pharmacological approach will contribute to developing more effective and less costly pain management strategies. This may result in a significant improvement in the experience of patients submitted to this surgical procedure.
● Trial registration: This study was prospectively registered in the Brazilian Clinical Trials Registry (ReBEC) on 01/02/2024 under registration number RBR-96h3k97.
... including particularly nutritional status of patients [3,[7][8][9]. Early mobilization is another important factor affecting postoperative functional status and mortality rates in geriatric patients with hip fractures [5,6,[10][11][12][13]. In this context, hip arthroplasty has become a widely used modality of treatment for geriatric patients. ...
... Other important findings are that PNI values tended to decrease with increasing age and preoperative requirement for blood transfusion and postoperative hospital stay increased in the group with low PNI values. Hip fractures are a major health problem for the elderly population because the incidence of fractures increases with age and are associated with a high mortality rate [10,19,20]. Therefore, elucidation of the factors affecting mortality after geriatric hip fractures is still of current interest. ...
... In geriatric patients, length of hospital stay after hip fracture increases in correlation with the increase in the number of comorbidities such as heart failure, diabetes mellitus, and renal failure [10,13,19,20]. One of the factors affecting length of hospital stay is the nutritional status of the patient at the time of admission. ...
Introduction
Hip fracture is very common in advanced ages, and it is very likely that this condition is accompanied by nutritional deficiencies. The aim of this study was to investigate the effect of prognostic nutritional index (PNI) on postoperative mortality in geriatric patients who underwent hip arthroplasty for femoral neck fracture.
Materials and methods
Geriatric patients (aged ≥ 70 years) who underwent hip arthroplasty for femoral neck fracture were prospectively recruited. The patients’ demographic data, time until surgery, total hospital stay, perioperative blood transfusion, duration of surgery and anesthesia, serum albumin level, total lymphocyte count, PNI value, and first-year mortality were examined. They were divided into two groups as patients who died and those who did not die within the 1st year, and between-group comparisons for continuous and categorical variables were made using independent t test and Chi-square test, respectively. Receiver operating characteristic (ROC) curve was constructed, and a cutoff value for PNI was determined based on sensitivity and specificity values.
Results
The total number of participants was 124. The mean age was 80.40 ± 7.19 years: 77 (62.1%) were female and 47 (37.9%) were male. PNI was statistically significant for 1-year mortality in multivariate Cox regression analysis (p < 0.05). According to ROC curve analysis, the area under the curve for PNI level was found to be 0.764 (95% CI 0.670–0.857), and this value was statistically significant (p < 0.001). The sensitivity and specificity for the 38.4 cutoff value were 83.9% and 39.8%, respectively. The mean age, time after surgery, total hospital stay, and preoperative blood transfusion need were found to be statistically higher in the patients with low PNI levels (≤ 38.4) than those in the other patients (> 38.4) (p < 0.05 for all).
Conclusion
PNI seems to be an independent risk factor on mortality after hip fracture surgery in geriatric patients. PNI is a preventable and correctable risk factor that affects patient survival.
... The PENG block group demonstrated significantly better preservation of postoperative knee extension motor function at 6 and 12 h than the LPB group. These improvements allowed earlier mobilization after the hip fracture surgery and were associated with fewer complications, lower mortality, less pain, and shorter hospital stays [19][20][21]. Notably, no significant differences were observed between the groups in terms of performing physiotherapy. However, the ability of the PENG block to enhance exercise strength suggests improvements in physiotherapeutic performance. ...
Lumbar plexus blocks (LPBs) are routinely employed for analgesia in hip fracture surgery; however, a novel regional technique, the pericapsular nerve group (PENG) block, potentially offers comparable pain reduction while preserving motor function. Patients aged 45–90 years who underwent hip fracture surgery were allocated to receive either a PENG block or an LPB for analgesia. The primary outcome was the incidence of quadriceps motor block (defined as the paresis or paralysis of the knee extension) at 12 h postoperatively. The secondary outcomes included the performance time, the time to first analgesic requirement, postoperative intravenous (IV) fentanyl consumption, the ability to undergo physiotherapy at 24 and 48 h, complications, sensory and motor block assessments, postoperative numeric rating scale (NRS) pain scores, and patient outcome questionnaires. There was a significantly lower incidence of quadriceps motor block at 6 h (26.7% vs. 80.0%; p < 0.001) and at 12 h (20.0% vs. 56.7%; p = 0.010). The PENG block provided better preservation of the sensory block as well as better performance time (p < 0.001) and time to first analgesia requirement (p = 0.034), whereas the LPB resulted in lower postoperative IV fentanyl consumption at 24 h (p = 0.013). The PENG block demonstrated superiority over the LPB in preserving quadriceps strength and patient satisfaction without any substantial complications, despite higher opioid consumption within the first 24 h post-surgery.
... Surgical intervention is often considered the preferred treatment approach for hip fractures in elderly patients, to ensure early mobilization, reduce complications, and improve functional outcomes, and requires a delicate balance between achieving effective pain control and minimizing the risks associated with anaesthesia [2]. The choice between spinal and general anaesthesia for hip fracture surgery in older patients has been an ongoing debate in the past [3]. ...
Background: The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality. Methods: This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management. Results: Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer’s (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5–4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1–5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2–12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0–6.3; p < 0.001) were all significant predictors of mortality. Conclusions: This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.
... A study involving 406 consecutive patients following total knee arthroplasty showed that early mobilization could help reduce the length of stay, decrease postoperative complications, and improve functional outcomes [11]. Another study involving 240 patients undergoing hip fracture surgery showed that early mobilization was as safe as delayed mobilization in terms of the complication rate and indicated that early mobilization could help to reduce the postoperative length of stay and financial costs [12]. Additionally, in a pilot study conducted in a surgical/trauma intensive care unit in the southeast United States, the researchers applied their mobility protocol involving six activity events for mechanically ventilated patients. ...
Background
Given its apparent benefits, early mobilization is becoming increasingly important in spinal surgery. However, the time point at which patients first get out of bed for mobilization after spinal surgery varies widely. Beginning in January 2022, we conducted a study of early mobilization (mobilization within 4 h postoperatively) following multi-segment lumbar decompression and fusion surgery in elderly patients. The study goal was to better understand elderly patients’ perceptions of early mobilization and ultimately contribute to the improvement of elderly patients’ perioperative experiences and quality of life.
Methods
We employed a qualitative descriptive study design involving face-to-face semi-structured interviews. Forty-five consecutive patients were invited, among whom 24 were enrolled and completed the qualitative investigation from February to June 2022. Of these 24 patients, 10 underwent early mobilization (mobilization within 4 h postoperatively) and 14 underwent mobilization at ≥ 24 h postoperatively. Three researchers conducted a 15-question interview the day before each patient’s discharge. The interviews were audio-recorded, and content analysis was used to assess the data.
Results
Six themes regarding the patients’ experiences and concerns about early mobilization were identified: worries, benefits, daily routines, pain, education, and support. The study results revealed the obstacles in early mobilization practice and highlighted the importance of perioperative education on early mobilization.
Conclusions
Clear and explicit guidance on early mobilization and a multidisciplinary mobilization protocol that incorporates a comprehensive pain management plan are essential for effective patient education. These measures may have positive effects on reducing patients’ stress and anxiety regarding postoperative early mobilization.
... [1][2][3] While physical therapy can help combat postoperative muscle atrophy and its negative consequences, muscle atrophy often persists despite progressive rehabilitation. 4,5 Understanding the biochemical mechanisms of disuse musculoskeletal atrophy, as well as formulating strategies to counteract it, is therefore a high priority for improving clinical outcomes after orthopaedic surgery. [6][7][8] Decreased muscle mass and function due to unloading results from the balance between protein synthesis and degradation shifting in favor of degradation and net protein loss. ...
Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence supports oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed
(MEDLINE), Embase, Scopus, and Web of Science were searched for randomized controlled trials that assessed protein or amino acid supplementation in patients undergoing orthopaedic surgery. Two investigators independently conducted the search using relevant Boolean operations. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to evaluate long-term effects of protein supplementation and to establish standardized population-specific regimens that maximize treatment efficacy in the postoperative period.
... Acute pain and decreased mobilization, which are frequent following traumatic injuries (Berube et al., 2016;Kenyon-Smith et al., 2019), were recognized as important precipitating factors associated with the development of delirium (Ormseth et al., 2023). A meta-analysis on the use on multimodal programs to prevent delirium, including pain management and early mobilization strategies, shows that these programs reduce the incidence of delirium and its duration by 40% and 20% respectively (León-Salas et al., 2020). ...
